Abstract

Background Chemoembolization of hepatic melanoma metastases refractory to treatment using irinotecan-loaded DC beads [embolic Drug-Eluting
Beads]: a novel palliative treatment with which there is as yet little experience.

Purpose To show the progress of a clinical case of metastatic choroidal melanoma treated with irinotecan-loaded DC Beads.

Materials and Methods The pharmacy department loaded the particles with irinotecan ourselves and monitored the patient through the clinical history.
The patient was a 38-year-old man with stage IV choroidal melanoma in the left eye (2007).

Results In October 2011, 4 hepatic nodules were detected: 3 in segment VII (23, 25, 11 mm) and 1 in segment II (16 mm). 2 cycles
of dacarbazine treatment (1649 mg × 1day) stabilised the disease. The patient experienced emesis and diarrhoea. Given this
intolerance and negative BRAFV600E mutation, ipilimumab reinforcement treatment was administered (225 mg × 1day q21days).
After 4 cycles of ipilimumab, the disease stabilised for 5 months. In May 2012, an increase in size of the nodules was described
and 6 new nodules in both hepatic lobes: segment II (42 × 34 mm), IVb (15 mm), VII (25, 26 and 61.4 × 43 mm) and VIII (14
mm) were observed. Surgery was rejected due to the presence of multinodular lesions and transarterial chemoembolization with
irinotecan-loaded DC beads was attempted.

Hypervascular lesions were observed in the distal branches of the hepatic artery by bilobar hepatic arteriography using selective
catheterization of both hepatic arteries. Subsequently, hepatic chemoembolization was performed by administering 100 mg irinotecan-loaded
beads (75–100 microns). After 2 cycles in each hepatic lobe, treatment response was assessed by the RECIST criteria. One month
after the last chemoembolization, stable disease (no new nodules and arterial necrosis <30%) was confirmed. No immediate complications
were observed, except for a slight elevation of hepatic enzymes that resolved.

Conclusions Hepatic chemoembolization using irinotecan-loaded beads is a viable alternative with good prognosis for hepatic metastases
of choroidal melanoma. A higher concentration of chemotherapeutical drug is achieved within the hepatic lesions using lower
doses of irinotecan, which therefore has less systemic impact.